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Objective: To evaluate patients with prosthetic valves who developed infective endocarditis by comparing treatment outcomes in both early- and late-onset IE episodes following prosthetic valve replacement surgery. This study sought to conduct a comprehensive assessment of the efficacy of these methodologies. The insights derived from this assessment can be utilized to enhance the quality of care for individuals with infective endocarditis who have undergone prosthetic valve replacement surgery. Results: During the period of investigation (January 2017–December 2022), 78 patients diagnosed with infective endocarditis (IE) on a prosthetic valve were admitted to the Infectious Diseases Department of the “Dr. Carol Davila” Central Military Emergency University Hospital in Bucharest. In 28 patients (35.8%), the onset of PVE occurred within 12 months of surgery (early onset), whereas in 50 patients (64.2%), the onset occurred more than 12 months after surgery (late onset). The mortality rate was 35.9% (53.6% among the early onset patients and 26% among the late-onset patients). Among patients who received surgical and medical therapy, the mortality rate was 29.6%, whereas among those who received only medical therapy, a 39.2% mortality rate was reported. According to the extracted data, antibiotic therapy was successful in 72.6% of the patients. In contrast, a combination of surgical and drug-based approaches resulted in a cure in 76.1% of patients. The most common etiological agent was Staphylococcus aureus (38.5%), followed by Enterococcus faecalis (26.9%) and Streptococcus mitis (10.3%). The mortality rate of patients infected with S. aureus was 29.2%, indicating the severity of this infectious agent. Conclusions: Prosthetic valve endocarditis (PVE) is a serious condition associated with a high mortality rate both in the short and long term. Regardless of the therapy used, the risk of death remains high.

Background: Histological findings of infective endocarditis (IEs) in mechanical valves present a complex diagnostic challenge owing to the lack of a precise definition. This ambiguity is further complicated by the natural degenerative processes that occur in the mechanical valves over time. Consequently, pathologists and clinicians face significant difficulties in distinguishing between genuine infective processes and the normal wear and tear of mechanical valves. Method: This retrospective cohort study was conducted between January 2017 and January 2024 and examined tissue samples from 93 patients who underwent a surgical removal of mechanical heart valves, with 41 cases suspected of infective endocarditis and 52 cases of non-IE. The researchers aimed to establish more precise histological criteria for distinguishing between these two conditions, focusing on two key features: vegetations and inflammatory patterns. Results: IE in patients with prosthetic heart valves presents distinct histological features that aid in the diagnosis and differentiation of non-infective complications. Hallmark characteristics include vegetation and inflammatory infiltrates with neutrophils. Valve tissue specimens from patients whose mechanical valves were removed because of non-infectious complications showed a different histological profile. Inflammatory infiltrates were observed in approximately 26% of these cases; however, they were primarily composed of macrophages and lymphocytes rather than neutrophils. Conclusions: By emphasizing neutrophil-rich inflammation as a key indicator, clinicians and pathologists could more effectively distinguish between true infective endocarditis and non-IE that can occur in the mechanical valves. This distinction is crucial for appropriate patient management as the treatment strategies for infective and non-infective valve conditions differ significantly.